Contract for Placental Encapsulation Services

Placenta Encapsulation Description

Placenta encapsulation is the process of preparing the mothers placenta after the birth of her baby(ies) (by separating
the membranes and umbilical cord from the placenta and rinsing and draining maternal and fetal blood) and dehydrating
it to then be ground and placed into capsules for the mother to ingest as she sees fit. The ingestion of the placenta is
known as placentophagy. The purpose of placentophagy by the mother is to reintroduce the beneficial vitamins,
minerals, hormones, proteins, and other nutrients to her body following labor and birth to help restore a more balanced
body function, prevent baby blues and the more serious postpartum depression, increase breast-milk production,
shorten healing time, increase maternal energy levels, and provide an over-all feeling of wellness to aid in the transition
between pregnancy and the early postpartum period in the woman who has just given birth.

Limitations and Disclaimer
Greenway Birth and Wellness and/or Kim Greenway is not a pharmacy, pharmaceutical representative, holistic
practitioner, herbalist, or medical doctor. Benefits of placentophagy are supported by ongoing research but have not
been evaluated by the Food and Drug Administration. Placentophagy, (as it pertains to this contract agreement, is for
natural nutritional supplementation and is intended solely for ingestion by the mother who has birthed the placenta(s)
and not for her family members, friends, or other individuals), is a natural nutritional supplement and as such cannot be
guaranteed to produce specific results.
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Service Description
Greenway Birth and Wellness (hereinafter referred to as GBW aka Kim Greenway) will prepare the clients placenta(s) at
the agreed upon time in the clients home, depending on previous agreed upon arrangements made between GBW and
said client, to be outlined in the Client Responsibility section below. Proper cleanliness and preparation precautions for
preparation of the placenta will be carried out by GBW to ensure the highest quality of placenta encapsulation possible
for the age and storage methods of the placenta(s) before the encapsulation process will provide a written explanation
of the proper storing and handling of the finished placenta pills and suggestions (not a prescription) for daily ingestion
recommendations.
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Client Responsibility
It is the clients responsibility to notify GBW as soon after the birth as possible (preferably the
same-day as the birth itself) to request preparation of the placenta(s) by GBW. Failure to do so may result in delayed
placenta preparation and encapsulation and may cause decreased potency of nutrients, hormones, and other beneficial
attributes of the placenta(s), and even spoilage of the placenta(s) which would render it unusable for encapsulation. It is
also the clients responsibility to discuss release of her placenta(s) after her birth from the establishment where she
delivers and to ensure proper storage of her placenta(s). Placenta(s) will be sealed in two double zip bags, transported
on ice in a cooler, if necessary and refrigerated or frozen until the arrival of GBW for preparation and encapsulation.

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It is also the clients responsibility to inform GBW of any known blood-borne illness(es) or other health issues that I, Kim
Greenway, may become infected with through contact of bodily fluids (specifically maternal and fetal blood and amniotic
fluid), such as HIV, hepatitis, STDs, etc.

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Fees
WDS Encapsulation Service includes:
The full placenta preparation and encapsulation process in your home
Proper storage container of the completed placenta pills
Written instructions for proper storage and handling of the finished placenta pills
Suggestions for ingestion amounts
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The above outlined GBW Encapsulation Service is provided for a total fee of $___200______.
This includes a deposit (possibly non-refundable, see below) of $___100_____.
If multiple payments are to be made by the client, they shall be outlined and initialed here by
GBW and the client.

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The balance of the total fee shall be paid in full by the time placenta pills are finished, unless otherwise specified here:

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Refunds
The policy of refund of payment is as follows:
There may be circumstances under which your placenta cannot be encapsulated: This includes the development
of maternal fever during labor and a situation in which your practitioner sends the placenta to Pathology for
further examination. In either event the contract will be terminated and the deposit will be refunded.
If the client chooses to terminate the contract, thereby voiding the agreement for placenta encapsulation by
GBW, the client must contact GBW to terminate the contract at least 24 hours BEFORE GBW arrives to prepare
the placenta(s) originally intended for encapsulation.
If the client chooses to terminate the contract after GBW has started preparation of the clients placenta(s) for
the encapsulation the original deposit will be retained by GBW and the placenta will be given back to the client
so that the client may dispose of the placenta(s) properly.
If the client decides that she does not want the finished placenta pills, the client will NOT be refunded any
moneys already paid to GBW and will owe GBW the balance of the fee previously agreed upon if the balance is
still owed (i.e. no refund or waiving of fees will be made).

In signing this Contract, you agree that you have read and understand the Service Descriptions
and Agreement for Wiregrass Doula Services Placenta Encapsulation Service and that you agree
to the terms and conditions outlined therein, as well as the stated fee.

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Client's printed name

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Client's signature Date

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GBW (Kim Greenway) printed name

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GBW signature Date